Book Reviews

Rivers ofFlorida is an edited book originating from a conference held in Tallahassee in 1987 concerning ecological relationships and current conditions of the major river systems in Florida. Indeed, these issues are highly relevant in that river systems in Florida are physically and biologically diversified and have been highly modified because of population pressures and rapid growth in development. The book is largely qualitative and is intended primarily for ecologists rather than geomorphologists or hydrologists, but could be useful for other scientists conducting interdisciplinary studies of rivers.

equally important publications. In the school of these two eminent practitioners has Broussais gathered those fundamental principles on which he has since built a system which he calls his own,?inututo nomine tantum; just as the retailer in court trappings, who, having by a lucky chance succeeded in possessing himself of a costly dress at a cheap rate, covers it with tarnished tinsel to increase, as his own taste suggests, the value of it, and vends it, as his own, to the amateur of private theatricals, or for the purpose of a masquerade, or to assist at a coronation.
The present is the second edition of a book which the author published in 1816, with nearly the same title, and which was introduced to the knowledge of the public in this country through various channels, by means of quotations and occasional references. Its purport ^en, as in the present instance, was to give an account of what were considered by the author to be the most prevailing doctrines in medicine of the day, accompanied by his own animadversions, and a slight glance at the then risingsystem of the principal physician of the Hospital of Val de Grace.f This latter object Dr. Broussais has so far enlarged upon in the present edition, that, instead of mere suggestions, hints, and Elusions, by which alone the reader could collect, in the first edition, the author's ideas of practical medicine, we are now presented with a code of " Propositions," constituting the skeleton of his system, with an appropriate name, to give it dignity, and to secure to it an everlasting reputation. The fact is, that Dr. Broussais has grown bolder since certain journalists on the continent have undertaken to sing his praises, upon a mere national principle, that of securing to France tfie additional honour of another 44 homme illustre," without condescending to inquire at what other nation's expence the " illustrious author" has secured to himself a certain degree of notoriety.
As we neither have space nor inclination to enter very minutely into details of the work itself, we shall limit our labours to the giving ?f a naked outline of the present edition, in order that those of our readers who may admire its construction may have the opportunity of referring to the volumes themselves for more ample information.
A general view of the principles of Rasori, Tommasini, and of other pro-?"?}er? of the physiological pathology in Italy, was given in the Proeiniuui to the 4 of this Journal.
Ihe medical appointment of Dr. Broussais, . Foreign Medical Science and Literature.
Dr. Broussais lays the foundation of his " Doctrine Physiologique" in a series of " propositions de medecine," amounting to four hundred arid sixty-five, which may be considered as so many points of his 4{ creed," to be looked up to, meditated, and followed, by his proselytes u here and every-where." These propositions are classed into so many sections, the first of which is entitled Physiology; the second, Pathology; the third, Therapeutics; the fourth, Corollaries.
As it is upon a better use of physiology that Broussais particularly piques himself, for the essentiality of his system, and its superiority to every other, it may not be amiss to remark, merely en passant, that the following propositions, some very new, others very true, and here and there a gratuitous one, are among the four hundred and sixty-five by which the Broussaian, or physiological, system is constituted.
Our extracts must be limited to only a few samples. (Gratuitous.) I. " La vie de 1'animal ne s'entretient que par Ies stimulants exterieurs." This is one of the hundred absurdities of Brown.
(New.) XXVI. <?H est un ordre de nerfs situes Ie long de la colonne vertebrale." That is to say, there are nerves along the vertebral column; a fact with which Mr. Broussais' readers were, perhaps, not aware before.
(True.) XXV. " L'embryog6nie estl'ouvrage de la chimie vivante: la sensibilite et la contractilite conduisent l'embryon dans l'uterus ; la chimie vivante le developpe et lui donne sa sensibilite et sa contractilite particulieres: la sensibilite et la contractility de la mere, en op&rent 1'expulsion." This is the neatest picture of conception, gestation, and parturition, that we ever remember to have seen drawn up in so few words. The dry aphoristical language employed by the author on this occasion, would lead one to believe that he can easily demonstrate what he has advanced in the above proposition. Unfortunately for him, demonstration is the only process wanting to prove the truth of his proposition. There arc, however, some hundred more such, the truth of which is equally evident, among the four hundred and sixtyfive. As for the examples of Dr. Broussais' disposition of wantonly rioting in the pleasures of chimerical inventions, where one would expect nothing but what is tangible and evident (in physiology), they are so numerous that we cannot venture even upon their computation. What do our readers think, for instance, of the following flight of fancy: XLVII. " Passions, like folly, are the triumph of the viscera, and consequently of instinct, over intellect. Hence they often give rise to folly."?P. xiv.
Into the other sections space will not permit us to enter in detail. Having thus framed a system of inedicinc by means of various pro-Positions, the majority of which are taken for granted, and are no lerc discussed and demonstrated, Dr. Broussais proceeds to take a Philosophical view of the doctrine of Hippocrates, as well as of those 42(5 Foreign Medical Science and Literature. effect, of those fevers and?that, consequently,Tommasini had completely anticipated Dr. Broussais in thostj tenets which he afterwards developed in his book on Phlegmasia?. This concession of our author does not surprise us more than his pertinacity in continuing to call himself the founder of a doctrine which Tommasini has inculcated for the last fifteen years ; and to which, as we have already observed, (mutato nomine taniumDr.Broussais has merely the credit of having added the knowledge of a physiological fact,?viz. that the seat of inflammation in fevers is either in the mucous or serous membranes. This fact, however, we contend, he has generalized with a facility which actual observation docs not warrant us in adopting; for the character, nature, and treatment, of several diseases must be greatly distorted, in order to refer them to an irritated condition of either the serous or mucous tissues of the viscera.
As the confession of Broussais himself on this subject must put an end to all doubts respecting the reality of the claims of the modern Italian school to the foundation of that doctrine which has been, more or less, acted upon in every civilised country in Europe, within the last ten or fifteen years; and must thus effectually silencc those expounders of the Broussaian system, who, ignorant of the above historical facts, both here and on the continent, have, either in separate works or in Journals, gone further than Broussais himself, in attributing to the French physician the judicious innovations that have been recently introduced into the practice of physic; we shall be excused if we record it in our author's own words. " Tommasini publia, des 1805, que le caractere stlienique des maladies febriles ne se borne pas aux premiers jours. Au lieu dc passer au traitement stimulant pour dissiper la pretenduc faiblesse indirecte qui survicrit, d'apres Brown, aussitot que la prostration musculaire, le r?trecissement du pouls, la couleur terne, les symptomes nerveux, succedent a la force du pouls t\ la coloration fleurie des premiers jours, il osa persister dans le traitement antiphlogistique. Bientot les cures qu'il obtiut le convainquircnt que les traces de phlegmasies qui se rencontrent dans les cadavrcs des malades enlcves par les fievres prolongees, et dc toutes les consomptions avec pyrexie, n'etaient point PefTct de la faiblesse indirecte ; des.lors il soutint que la nature stlienique des maladies se conserve la meme depuis le premier moment de l'invasion jusqu'au dernier degre de l'epuisement; que toutes les inflammations aigues, chroniques, evidentes, obscures, sont de cette nature jusqu'ii l'entier epuisemcnt des forces, et qu'en tin mot les phlfgmasits, dont on rencontre les traces apres la mort, sont tovjours la cause et jamais Vejfct desjievres qui ont existt durant la vie. " Co point ayant ete 6clairci, on s'eleva contre l'assertion dc Brown, qui soutient que la majorite est tellement en favfcur des maladies astheniques, qu'il en existed peine trois sur cent que l'on puisse rapporter a la classe des stheniqucs. La distinctions des injlammalions en stheniques et en astheniques Jut done regardee comme illusoirc et purement speculative.
causes qui I'avaicnt produite. Cet auteur, etay6 par les ouvertures ' cscudavrcs ct par le succes des antiphlogistiqucs, soutint que dc 1'ac-?on des causes les plus deprimantcs, tcls sont le froid et les affections r'stes, il resultait une foulc dc maladies csscnticllcment ct pcrseverammcnt d'un caract&re stheniquc ou de sur-irritation, cxigcant imperturbablcmcnt un traitcmcnt sedatif ; il s'aida, pour 6tablir ces Rentes, des vucs lumineuscs de Gaubius, de Cullen, dc Giaoini, dc Aesta, de Montcggia." ?ihe next medical doctrine which Dr. Broussais has undertaken to examine, is that of the German physicians, and those of the North of Europe in general. The two principal physicians, whose works he analyses and comments upon for that purpose, arc Joseph Frank and 1 rofussor IIildenbiiand. The doctrine of the former regarding fevers he considers as vague in the extreme ; and he, moreover, accuses the same author of giving stimulants in fevers. The  Foreign Medical Science and Literature. operated on Dr. Broussais, and have given a colour to his judgment on English medicine. The only authors, whose productions he analyses, and from the nature of whose lucubrations he infers what must be the state of medicine in this country, arc a Dr. Brenan, of Dublin, (we must give and spell the names as our critic spells them,) a Mr. /.
Thachtr, who happens to be in America, anil is an American, (though this seems of no great consequence to Dr. Broussais, in speaking of English practice;) Dr. llossack, another American practitioner, whose sins arc laid to the account of the English ; Mr. Homing, who has been foolish enough (says Dr. Broussais,) not to sec the connexion between the cutaneous eruption and gastritis in scarlet fever; Dr.
Scudamore, whose work on Gout Dr. Broussais praises, anil whose practice he condemns; the chirurgien Newnham,?a great weight, to be sure, in the balance of English practice; a Mr. Bowes, (who is he?) a Mr. Cliston, (who is he?) a Mr. Rogers, (who is he?) Dr. Kinglake, Dr. Burrow, Dr. Sutton, Dr. Park ; and, amongst the really eminent, Hunter, Abernethy, and Wilson Philip. Dr. Broussais' authorities arc principally the medical Journals; he having in a very few instances, indeed, referred to any of the important works of the last-mentioned authors.
As for the Transactions of the Colleges of

Physicians of London and Ireland, and of the Mcdico-Chirurgical
Society of London, in which arc deposited, we venture to say, more practical facts and useful doctrines than our critic will ever be able to comprehend, Dr. Broussais never hints at them, except in one single instance?that of Dr. W. Philip's paper on Hepatic Phthisis. We must, however, do justice to Dr. Broussais in one point, and that is iu the analysis he has given of Hunter's theory of inilammatiori. To say, however, that all the practitioners in England act upon that the* ory, is absurd.
Looking at the picture of English practice, as drawn by the great proportion of the artists which DrBroussais has named and selected, and with whose translated works alone he seems to be acquainted, no wonder that he should bring forward, against the English physicians of the present day, a string of accusations like the following: 1. Les medecins Anglais affaiblissent et stimutcnt dans les maladies aigues ; 2, ils ignorent la cause des gonllemens mesenteriques; 3, ils abusent lies purgatifs; 4, ils ne connaissent pas bien les phlegmasies cruptivcs; 5, ils voient mal les maladies des pays chauds; 6, ils con- The objects of this memoir are to render more generally known, in Italy, the author says, the new mode of operating for the stone proposed by Dr. Sanson, (an account of which was given, a short time since, in this Journal;) to render evident the advantages of this mode of operating; and to support the propriety of it, not only by reasoning, but also by some cases of a very important character: and, as facts persuade more than theory, Professor Vacc& thinks that he may hope to be more successful than Dr. Sanson had been in his endeavours to make surgeons in general adopt this, as he considers it, improvement in the art of surgery.
Wc shall give an abstract of the most remarkable parts of this memoir, (which merits every praise due to a work equally characterized by candour, liberality, and intelligence,) without adducing any considerations of our own on the merits of the practice which Professor Vacck advocates. The Professor has evidently thought well on this subject, and has presented a very perspicuous view of its relative advantages; whilst the modifications he has effected on the mode of Sanson show, as far as the evidence of six cases extends, that the principal relative disadvantage of it resulted from a circumstance which might, without much difficulty, be obviated. Of the two chief objections to the method of Sanson,?the consequences of the wound of the rectum, which appertain especially to the part itself; and the passage of fecal matter into the bladder, and, hence, a recto-vesical fistula ;*?the latter alone, the Professor considers, is of any validity, and it is this which he has obviated by the modification of the operation above alluded to. The method of Professor Vacca consists in cutting the urethra, the prostate, and the neck of the bladder, and avoiding the bas-fond of this viscus. In this operation, the incision of the intestine is at least an inch lower than that of the' neck of the bladder, and the edges of the wound of the lower part keep in contact except when the urine is passed, and the parietes of the intestine serve as a valve whicjx opposes the passage of feces into the bladder. The truth of these statements is proved by the six cases in which the operation in question was informed by Professor VacciL The author enters into an examination of the relative merits of the several modes of lithotomy hitherto proposed, the results of which lead him to infer that the recto-vesical operation " seems to unite all the principal advantages, and present the smallest inconvcniences.,,?
It is not necessary," he says, u to rccal to the mind of the reader knowledge of minute anatomy, to persuade him that there is no point of the perineum nearer to the bladder than that which corresponds * This occurred in the cases of Dupuytren, Barbantiiii, ami of Professor Geri, at Turin. Professor Vacca on Lithotomy by the Rectum. 431 to the anterior part of the sphincter of the anus. Not much ingenuity ?s requisite to enable us to conceive that, on dividing this point of tho sphincter, the parietcs of the rectum, the membranous portion of the urethra and the prostate, by an incision which intersects but few soft parts, we shall have procured a very ample space for the entry of the linger, the forceps, and the passage of the stone; because we profit bv the natural aperture of the anus, as well as by the cavity of the rectum. The grossest anatomical information is sufficient to lead any-Person to perceive that an incision which intersects the sphincter ol the anus in its anterior part, the membranous portion of the urethra the median line of its anterior paries, the neck of the bladder, the prostate, and the lower surface of the bladder, in the same line, docs not ever encounter any important vessel, or any other part interesting to life. It is clear that, by this method, the stone has to pass between the rami of the ischium, where they are most distant from each other, and where, consequently, they leave ample space for the passage ol the largest stone. It is also evident, that the direction and the shortness ?f the wound render impossible any extravasation of urine, as well as facilitate the egress of any fragments which may have remained in the bladder after the operation. The traject of the wound being shorter than in the other method, the surgeon can penetrate far into the bladder with his finger; ascertain the form, volume, and direction, of the stone; and, according to its situation, easily seize and extract it. In the recto.vesical operation, we avoid the danger of wounding large vessels in the perineum ; we may extract large stones as well as in the high operation; whilst this method is devoid of the inconvenience of exposing the peritoneum, and submitting it to the hazard of being Wounded by the surgeon, or the other very serious accident of rendering easy the extravasation of urine." Professor Vacca thought favourably of the high operation a few years since; but the results of his experience, and further considerations on it, have led him to alter his opinion in this instance. Notwithstanding the presence of a catheter in the bladder, effusion of urine into the cavity of the pelvis took place in the cases in which he performed the high operation, and this in a female as well as in male patients. This he considers the chief relative disadvantage of this, operation, though much difficulty in it ensued, in one case, (where the subject was a man twenty-five years of age,) from another cause that had not, we believe, been previously noticed: that is, from violent contraction of the abdominal muscles, after they had been cut, which rendered the wound so thick as not to admit even a finger without extreme difficulty, and obliged the operator to postpone the extraction of the stone to a subsequent period. 1 he same reasons which lead Professor Vacca to prefer the recto-vesical operation in roan, militate, he thinks, in favour of the vagino.vesical operation in woman.
The author has performed the recto-vesical operation in six instances. In four of these cases, (the subjects of which were patients of the ages of 38, 74, 38, and 2, years,) the results were of the most favourable kind; in one (the subject of which was five years old.) a 432 Foreign Medical Science and Literatures little fistulous communication existed between the rectum and thff bladder for nearly a year after the operation. This resulted, the author thinks, from the surgeon into whose care the patient was given, (in the absence of the Professor,) having neglected to touch the edges of the wound of the intestine with argentum nitratum,* (a practice adopted by Professor Vaccii, as soon as inflammation has subsided and suppuration established, and effected throughout the whole traject of the wound that corresponds with the incision of the intestine and the perineum.) In the other case, the patient (a man seventy years old,) died on the fourth day after the operation. Dissection showed inflammation of the peritoneum and of the left kidney. The cellular substance which united the anterior part of the bladder to the pubes was also gorged with blood, and bedewed with puriform serum. The parietcs of the bladder, at its upper and anterior surface, were much thickened ; there was puriform scrum between its muscular and peri* toneal tunics: the internal membrane was gangrenous, and presented, at its left lateral portion, some protuberances which contained several very small fragments of stone. It appears that the stone had been adherent to this point. The wound, also, presented a gangrenous appearance. The liver was very voluminous, and occupied a great part of the left hypochondrium.
To the general abstract above given, we shall add the detail of the process of the operation, according to the method of Professor Vacca, as it is described by the author himself.
The necessary instruments are only a common grooved staff, an ordinary straight bistoury, forceps, and, in some cases, a perfectly straight probe-pointed bistoury. The patient being placed and secured as for the lateral operation, the staff is passed into the bladder, and then confided to an assistant, "who is to hold it firmly in an axis perpendicular to the pubis, without inclining it cither to the right or the left, and keep the groove of it pressed against the median line of the urethra, opposite to (he raphe. The surgeon then takes the bistoury in his right hand, so that he may cut with it from within outwardly; that is to say, with the cutting edge turned upwards, and the fore-finger and thumb on the point of conjunction of the blade with the handle, so that both of them may be grasped. The fore-finger of the left hand is then oiled, and one of the sides of the bistoury pressed very firmly against its palmar surface, so that its -cutting edge may be a little below the upper surface of the finger, and form with it, as it were, one body, which may be passed into the rectum without wounding the patient.' The finger and the bistoury are then introduced through the anus, with the dorsal surface of the finger opposite to the sacrum, and advanced to the distance of ten or twelve lines from the verge of the anus : the finger is to be pressed against the posterior, or sacral, surface of the rectum, in order that a subsequent necessary change in the position of the instrument may be effected: this change is made by means of the right hand, and consists in applying the back of the instrument to the palmar surface of the finger, and its cutting edge to the anterior part of the intestine, exactly 'n a line corresponding with the raphe of the perineum. lhe finger, Which had been introduced to facilitate the change of the position of the bistoury, is then pressed forward against the instrument, the cutting edge and point of which, being fixed in the anterior part of the intestine, whilst the right hand, drawing the knife from the intestine^ Will co-operate in making an incision of the anterior paries of the intestine, the cellular texture situate between this and the urethra, and the'external sphincter of the anus ; beyond which sphincter the incision should not extend above the distance of eight or nine lines in the Perineum. On this being effected, (which is done in an instant,) the ?perator Removes the left fore-finger from the bistoury, alters the direction of this finger, turning to the left its dorsal surface, and at the same time, by a light movement, changes the position of the instrument; so that its cutting edge, which had been turned upwards and towards the operator, is placed in an exactly opposite direction. The operator now passes the end of his left fore-finger into the wound, exactly on a parallel with the incision in the sphincter, and seeks, with the edge of the nail (which should always be long when this ope-Medical and Physical Intelligence.
Professor thinks that the use of suture* in the wound of the sphincter of the anus, proposed by Dr. Sanson, is unnecessary and injurious. The only surgical measure generally requisite is the application of caustic to the edges of the wound, in the manner already described.